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Neurological Surgery No Shinkei Geka Volume 47, Issue 5 （May 2019）

Neurological Surgery 脳神経外科 47巻5号（2019年5月発行）

Japanese English

症例

くも膜下出血発症後，腹腔内出血を併発したsegmental arterial mediolysisの1例 A Case of Segmental Arterial Mediolysis:Subarachnoid Hemorrhage Followed by Abdominal Bleeding 稲塚万佑子 ¹ , 今里大介 ¹ , 山崎圭 ¹ , 前川達哉 ¹ , 高橋祐一 ¹ , 菊池麻美 ¹ , 横佐古卓 ¹ , 山田知香 ¹ , 新井直幸 ¹ , 黒井康博 ¹ , 大渕英徳 ¹ , 広田健吾 ¹ , 萩原信司 ¹ , 谷茂 ¹ , 平澤元浩 ¹ , 米山琢 ¹ , 笹原篤 ¹ , 糟谷英俊 ¹ Mayuko INAZUKA ¹ , Daisuke IMAZATO ¹ , Kei YAMAZAKI ¹ , Tatsuya MAEGAWA ¹ , Yuichi TAKAHASHI ¹ , Asami KIKUCHI ¹ , Suguru YOKOSAKO ¹ , Chika YAMADA ¹ , Naoyuki ARAI ¹ , Yasuhiro KUROI ¹ , Hidenori OBUCHI ¹ , Kengo HIROTA ¹ , Shinji HAGIWARA ¹ , Shigeru TANI ¹ , Motohiro HIRASAWA ¹ , Taku YONEYAMA ¹ , Atsushi SASAHARA ¹ , Hidetoshi KASUYA ¹ ¹東京女子医科大学東医療センター脳神経外科 ¹Department of Neurosurgery, Tokyo Women's Medical University Medical Center East キーワード： segmental arterial mediolysis , dissection , subarachnoid hemorrhage Keyword: segmental arterial mediolysis , dissection , subarachnoid hemorrhage pp.543-550

発行日 2019年5月10日 Published Date 2019/5/10

DOI https://doi.org/10.11477/mf.1436203979

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　Segmental arterial mediolysis（SAM）は，中〜小動脈に特異な病理所見を呈する紡錘状動脈瘤を形成する稀な疾患である⁶⁾．腹部内臓動脈瘤での報告が多いが^7,8)，頭蓋内動脈病変の症例も散見される¹⁵⁾．今回われわれは，内頚動脈瘤破裂によるくも膜下出血（subarachnoid hemorrhage：SAH）発症後，致死的な腸間膜動脈破裂による出血を合併し，剖検にてSAMによる頭蓋内および腹腔内動脈瘤と診断された1例を経験したので，文献的考察を加え報告する．

　We describe a case involving subarachnoid and intraperitoneal hemorrhage due to segmental arterial mediolysis（SAM). A 77-year-old female patient with sudden subarachnoid hemorrhage was immediately transferred to our institution. The hemorrhage was classified as grade 2 according to the World Federation of Neurosurgical Societies system. The patient was a non-smoker and did not drink alcohol regularly. A right internal carotid aneurysm was detected using CT angiography and was clipped during frontotemporal craniotomy. Bleeding was observed from the anterior wall of the internal carotid artery, and the tear was clipped. The patient had an uneventful postoperative course until sudden cardiopulmonary arrest eight days after craniotomy. She died of massive intraperitoneal hemorrhage. Autopsy revealed that the hemorrhage was due to dissection of the celiac artery. Tunica media denaturation was observed not only in the celiac artery, but also in the splenic and internal carotid arteries, which exhibited ruptured aneurysms, and the patient was diagnosed with segmental arterial mediolysis（SAM). SAM is an arterial degenerative disease affecting the medial layer of the arterial and dissecting walls. Multiple lesions are sometimes found. Radiographic imaging findings of SAM are similar to those of dissecting aneurysms, which are characterized by a single continuous dissection of the medial layer. As observed in this case, abdominal bleeding caused by SAM can occur after intracranial bleeding. When surgeons encounter unusual intracranial dissecting aneurysms, SAM should be considered as a differential diagnosis.